Authorization Specialist

Mc. Gregor PACE (Program of All-inclusive Care for the Elderly) is a community-based service program that provides in-home healthcare services to the elderly as an alternative to nursing home placement, allowing Seniors to remain at home. We are seeking a highly motivated and dedicated Authorization Specialist to join our team at PACE.

As an Authorization Specialist , you will be responsible for providing open communication with administrative staff, hospitals, and medical outpatient offices regarding the status of authorization requests, and related topics.

Responsibilities

Send authorizations in a timely manner to prevent billing delays and/or denial of payments. Prepare and complete prior authorization request forms and apply appropriate guidelines to prior authorization requests. Including inpatient, respite, ICF, skilled, and LTC within 24 to 48 hours. Prepare and complete authorization request forms for weekend admissions within 72 hours to ensure timely integration of data into Intus Care.

Prepare and complete authorizations for outpatient visits daily within the guidelines. Determine when the request does not meet PACE guidelines and coordinate appropriate follow-up by clinical staff members that aid in the prior authorization process. Respond to the designated authorization email address promptly for inquiries from providers as needed.

Respond to inbound calls as needed. Responsible for' entering discharge dates into the Electronic Health Record ( EHR) as the participant's status changes. Including hospitals, respite, and skilled, ICF, and LTC. Delete alerts if they are no longer valid. Update the PCP inpatient report with the authorization expiration dates as needed.

Notify PACE providers by email of request for authorization if no order is listed in Truehart, follow up within 2 business days for their response.

Minimum Qualifications

High School Diploma Minimum of 2 years experience in an office setting, Detail-oriented and ability to prioritize workload Proficiency in Windows environment and Microsoft Office applications, is required Ability to collaborate with staff at all levels Preferred Qualifications: Strong communication skills and customer service preferred.